Updated April 16, 2024
Access to Innovations Waiver, TBI Waiver and 1915(i) Services
People with Medicaid should receive the medical and community-based services they need to stay healthy and safe. It is important to be able to find good providers and staff in the community to provide these services. But sometimes services are approved, and it is impossible to find someone to provide them. Other times, you may have problems with your providers or their staff. When that happens, you can file a complaint (called a “grievance”) with your LME/MCO/Tailored Plan.
How to file a complaint with your LME/MCO/Tailored Plan
There are several actions that you can take to advocate for the services you need. Refer to this step-by-step guide when you feel like you have tried everything and you need to file a complaint. If possible, always make your requests in writing (an email is great) to make sure you have documentation of your complaint.
1. Report the problem in writing to your Care Manager/Care Coordinator
If you verbally report your problem, follow up the call with an email that summarizes what you talked about.
2. Contact the Customer Service and Community Rights Team at NC DHHS
You can contact NC DHHS Customer Service by email at dmh.advocacy@dhhs.nc.gov; or by phone at 984-236-5300 or 1-855-262-1946 (NC residents with NC area code only).
3. File a Grievance with your LME/MCO/Tailored Plan
Put your grievance in the form of a letter or email. Grievances should always be in writing. The MCO/TP is required to respond within 30 days. Additionally, the State must review the grievance as part of monitoring the MCO/TP. Find your LME/MCO/Tailored Plan below for directions on how to file a grievance.
4. Send an email to key decision makers
Explain the problem that you (or a family member) are having finding a provider and/or receiving services, and how that lack of service is negatively impacting you. Send your email to the following individuals:
North Carolina Department of Health and Human Services:
Kody Kinsley, Secretary of NC DHHS: Kody.Kinsley@dhhs.nc.gov
Jay Ludlam, Deputy Secretary for NC Medicaid: jay.ludlam@dhhs.nc.gov
The Leadership at your LME/MCO/Tailored Plan
The Chief Executive Officer (CEO), Chief Medical Officer (CMO), and the Board of Directors (see below for their contact information)
5. Tell your story to your North Carolina state legislators
Your state legislators may be able to advocate for you. It is important that policy makers hear your story, so they know how the laws they write affect their constituents. Find your NC House and NC Senate representatives.
6. If your issue involves a regulated provider or unlicensed health care personnel, you may also contact NC DHHS Division of Health Service Regulation (DHSR)
Complaint Intake is available to receive complaints regarding the care and services provided to patients/residents/consumers by health care facilities/agencies/homes licensed by the Division of Health Service Regulation. File a complaint.
Complaint Intake Telephone: 1-800-624-3004 [Toll free – N.C. residents only-must have an NC area code] or 919-855-4500 [local & outside North Carolina]
Complaint Hotline Hours: 9:00 a.m. – 12:00 p.m. and 1:00 p.m. – 4:00 p.m. weekdays, except holidays.
Contact info for each LME/MCO/Tailored Plan
Find your LME/MCO/Tailored Plan in the list below: We have included the contact information for some key people (Chief Executive Officer (CEO), Chief Medical Officer (CMO), and the Board of Directors) to send your complaint to along with information about filing a grievance.
Alliance Health
5200 Paramount Parkway, Suite 200
Morrisville, NC 27560
919-651-8401
Rob Robinson, CEO: rrobinson@alliancehealthplan.org
Dr. Robert MacArthur, CMO: RMAcarthur@alliancehealthplan.org
View the current Board of Director members for Alliance Health.
To contact the Board of Directors, email the Executive Assistant, Veronica Ingram at vingram@alliancehealthplan.org and request that she forward your complaint to the Board members. You can also request email addresses for the board members.
File a grievance: mail to: Complaints@alliancehealthplan.org
Partners Health Management
901 South New Hope Road Gastonia NC 28054
704-884-2501
Rhett Melton, CEO: rmelton@partnersbhm.org
Dr. Charles “Steve” Edwards, CMO: csedwards@partnersbhm.org
View the current Board of Directors for Partners Behavioral Health.
You may send a copy of the complaint to tpyles@partnersbhm.org and request that Ms. Tammy Pyles (Clerk to the Board) share copies of your complaint with the board members or provide you with their email addresses.
File a grievance: Grievances@partnersbhm.org
Feedback form: https://www.partnersbhm.org/feedback/
Trillium Health Resources 201 W. First Street Greenville, NC 27858
866-998-2597
Joy Futrell, CEO: Joy.Futrell@TrilliumNC.org
Dr. Michael Smith, CMO: Michael.Smith@TrilliumNC.org
View the current Governing Board.
You may send a copy of your complaint to Lisa Fuller, Clerk to the Board at Lisa.Fuller@TrilliumNC.org . Request that she share a copy with all Board members or provide you with their email addresses.
File a grievance: Complaint/Grievance
Vaya Health
200 Ridgefield Court, Suite 206
Asheville, NC 28801
828-225-2785
Tracy Hayes, CEO: tracy.hayes@vayahealth.com
Dr. Richard Zenn, CMO: richard.zenn@vayahealth.com
View the current Board of Directors.
You may send a copy of the complaint to the Board clerk at: board.clerk@vayahealth.com . Request that your complaint is distributed to Board Members or that they send you the email addresses for Board Members.
File a grievance: resolutionteam@vayahealth.com